Provider Demographics
NPI:1477835478
Name:CELKUPA, ROBIN H (PHD, MSSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:H
Last Name:CELKUPA
Suffix:
Gender:F
Credentials:PHD, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 MONTFORD RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7839
Mailing Address - Country:US
Mailing Address - Phone:406-471-3106
Mailing Address - Fax:406-257-6173
Practice Address - Street 1:690 N MERIDIAN RD STE 205
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3508
Practice Address - Country:US
Practice Address - Phone:406-471-3106
Practice Address - Fax:406-257-6173
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT529-LCSW1041C0700X
WALW 000093471041C0700X
COLCSW 9918001041C0700X
ORL6001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health